Cognitive and neuropsychological correlates of the attention training technique: a systematic review and evidence synthesis.

Introduction: The Attention Training Technique (ATT) is a brief metacognitive intervention recognised as a possibly efficacious standalone transdiagnostic treatment for emotional disorders. The cognitive and neuropsychological mechanisms underlying its clinical effects are of particular interest in understanding and developing the technique. The aim of the systematic review was to synthesise and evaluate the cognitive-attentional task performance and neurocognitive correlates of ATT in the context of theoretical mechanisms from which ATT is derived. Methods: Five electronic databases (PsycINFO, MEDLINE, PubMed, Web of Science and EMBASE) were searched from January 1990 to November 2025. Studies that used ATT as part of a metacognitive multi-component treatment package or combined with other therapy/technique(s) were excluded. Sample inclusion was diverse to capture effects on non-clinical and clinical individuals and across age groups for potential sub-group analyses. Results: In total, 20 studies with 1, 230 participants met the inclusion criteria. Four studies included clinical samples, four studies included non-clinical participants, two studies used experimental induction of pain or mind wandering, and 10 used healthy samples of which two used school children. Study quality varied from strong to weak with the majority receiving 'moderate' ratings. Across 14 cognitive-attentional tasks and three neural methodologies (EEG, fNIRS, fMRI), the review found small to large cognitive and neural effects associated with ATT. Nine cognitive tasks showed significant ATT-dependent effects in at least one study, with the most consistency shown on the emotional dot-probe. Neural findings across all methodologies converged, suggesting that ATT modulates cognitive control, frontoparietal, dorsal attention networks and reduces default mode network connectivity. Discussion: Interpretation and synthesis of findings based on the S-REF model are consistent with cognitive and neural effects involving reduced threat monitoring, improved executive control, and enhanced disengagement from self-referential processing; central theoretical mechanisms and design parameters of ATT. Where inconsistencies across study effects emerged, they may be due to heterogeneity in cognitive task and measurement factors and ATT protocol deviations. Future research on individual differences in neurocognitive effects associated with ATT across clinical and sub-clinical populations is needed. Studies must safeguard fidelity and adherence to the ATT protocol and improve reporting of these important factors. Systematic review registration: https://www.crd.york.ac.uk/prospero/, identifier CRD42024483053.